Her painwas so bad that she completely avoided having sex. She measured the severity ofher pain on a one to ten scale, with one being low and ten being high:

• Dysmenorrhea: 10
• Chronic pelvic pain: 7
• Dysapareunia: 10
  

Shealso had a “normal cervix, a mobile, anteveted mildly enlarge uteruscaused by myomata (benign tumors), and the absence of adnexal masses(lumps in tissue near the uterus, usually in the ovary or fallopiantube).”

The doctors werejustifiably confused, and even performed surgery tohelp relieve the pain, however, after six months her symptoms returned. She wasonly partially responsive to their “analgesic, antispasmodic, andantidepressant” drugs. She had no obvious gynecologic disorder.

During subsequent examinations the doctors discovered an issue related to malabsorption, and the patient was tested forgluten antibodies. The results were positive, and the woman was put on a gluten-free diet. After one year on a gluten freediet the woman’s pain disappeared, along with her other symptoms offatigue, depression, and general intestinal issues.

Accordingto this article, 40% of cases of pelvic pain in women have no known cause, even if they have been diagnosed with irritable bowelsyndrome or inflammatory bowel diseases. According to the doctors: “Celiac disease should betaken into consideration when a patient presents with unexplainedpelvic pain, dysmenorrhea, or deep dyspareunia if these symptoms areassociated with bowel disorders, even in the absence of a knownintestinal disease.”

Reference: Open Original Shared Link.

The Centers for Disease Control and Prevention (CDC) website has a page dedicated to antiviral medicines and swine influenza. That website contains the following information:

To treat H1N1/swine flu, or prevent the flu in people one year of age or older who have been exposed to the virus, the CDC recommends oseltamivir (Tamiflu®). When contacted, Roche representatives stated that all Roche products, including Tamiflu, are gluten-free.

To treat H1N1/swine flu infection in people 7 years of age and older, or to prevent infection in people 5 years and older, the CDC recommends zanamivir (Relenza®). When contacted, GSK representatives stated that gluten is not one of the active or inactive ingredients in Relenza, but that GSK cannot guarantee that the product is free from potential cross-contamination.

Please be aware that this information applies only to products available in the U.S. For drugs obtained internationally, contact the manufacturers directly.

Resources:

Zanamivir (Relenza)
Glaxo Smith Kline
(888) 825-5249

Oseltamivir (Tamiflu)
Roche Pharmaceuticals
(800) 526-6367

Source: Nancy Lapid, Open Original Shared Link

1. Be sure to make a copy of this checklist, distribute it to your family members, and keep it with you during your hospital visit.
2. Keep this checklist with your chart of current medications, along with the names and addresses of each of your health care providers.
3. Present a copy of this checklist to the managing nurse of the ward where you will be staying. It's also a good idea to make sure a copy goes to the pre-admission staff to ensure the information is placed at the front of your chart or documented in your computerized medical record. Be sure to ask that it be made easily visible to anyone inspecting your chart.
4. Arrange for a written note from a doctor mandating a gluten-free diet. Be sure that the note clearly labels your condition as an allergy, so that there is no confusion among the staff about your dietary needs. If your visit requires you to be admitted, then, prior to your admission, arrange to meet with a representative from the departments that will be involved in your stay, such as pre-op, surgery, medical/surgery, pharmacy, nutrition services-dietitian, rehabilitation, etc.
5. Ask for a allergy alert wristband, and consider requesting that the following words be printed in BOLDFACE on your chart, near your bed, or on the outside of your door: Celiac Disease: All foods and medications must be verified gluten-free!
6. See if you can bring food and medicines you know to be gluten-free. If permitted, clearly label all food and medicine containers with your full name, date and room number.
7. If your visit is unplanned, then arrange to speak with the hospital's Registered Dietitian as soon as you can. If you're unable, then make sure your family or care-giver knows in advance to make this arrangement. Since some dietary staff members may be unfamiliar with the intricacies of the gluten-free diet (Diet Technicians, Nutrition Assistants, Meal Assistants, etc.), it's good practice to speak directly with the Dietitian.
8. Work with the Dietitian. Find out how the hospital chooses its gluten-free foods, and how those foods are processed in the kitchen. Find out who is in charge of for approving the hospital's gluten-free offerings.
9. Bring some non-perishable gluten-free back-up snacks as rules permit. Gluten-free favorites like cookies, crackers, condiments, and cereal are easy to store. Label all food with your full name and room number.
10. For a scheduled visits, see if you can get the dietary department to order some special gluten-free pasta, muffin mix, cake mix, or bread to make during your stay. Ask if you can supply your own. If a dietary staff offer to make shop for you, remind them not to select food from bulk bins.
    

A thorough physician will test for and sometimes treat underlying vitamin and mineral deficiencies common in malabsorption disorders such as celiac disease and gluten intolerance, and after three-to-six months, many symptoms related to such deficiencies will resolve.  Some alternative practitioners even offer injectables such as B-Vitamins and Magnesium.  Oral supplements range from plant-based liquid concentrates, to sublingual drops, to tablets and capsules, allowing a range of options for sensitive individuals.

Recently I spoke to a gluten intolerance group where a woman raised an important question.  She described her symptoms, which included profound fatigue and asked, “What can you do if extreme fatigue persists on a strict gluten free diet and supplements, even after a year or two?”  At the time, I wasn’t sure how to answer her, other than to suggest, off the top of my head, that she ask her Naturopath to do a saliva-based adrenal function panel.  I guess my reasons for doing so were based on fifteen years of nursing experience and the fact that she was probably about my age, and possibly in peri-menopause, which I knew places an additional strain on the adrenals.

In women the sex hormones are produced in varying amounts in both the ovaries and adrenal glands.  A smooth transition through menopause would involve a gradual transition that decreased production of sex hormones by the ovaries, and increased production of sex hormones by the adrenal glands.  But, what happens if there are other factors in a woman’s life that prevent the adrenals from assuming this additional burden?  Coupled with the added strain that menopause places on the body and indirectly on the adrenals, a triggering event like a significant accidental gluten exposure, an increase in food allergies, or infection with a virus or bacterial illness, could simply tax the adrenals beyond their ability to meet this increased demand.

The Gluten Connection

Although relatively tiny, the adrenals have a very big job.  Adequate levels of the adrenal hormone cortisol are required by the body to help prevent inflammation and tissue destruction, keep blood sugars level, moderate nervous system responses, and attempt to maintain homeostasis, or the steady-state of balance in the body.    Periodically experiencing incredibly painful episodes of inflammation and tissue destruction from an accidental exposure to gluten, the protein found in wheat, barley, and rye, places a huge strain on the adrenals, including a sudden demand for high cortisol levels to help moderate the inflammatory response.  Each time, the body is able to cope, but with each experience it may take longer for the adrenals to recover.  When stress is prolonged, these high levels of cortisol must be maintained.  And if there is no significant recovery period during which the adrenals can rest and replenish themselves, adrenal fatigue results.

After doing some research for a new book I’m working on, I found another possible connection, especially for those with celiac disease.  Many of us are aware of the strong, well-documented association between celiac disease and autoimmune thyroid disorders like Hashimoto’s thyroiditis.  We also know there is a relationship between celiac disease and another endocrine gland, the pancreas.  (Diabetes has a strong correlation with celiac disease.)  Autoimmune hepatitis affects the liver – the body’s largest internal organ. Nephropathy, which affects the kidneys, is a very serious, less familiar disorder linked to celiac disease.  But, we rarely hear about the adrenals, especially in relation to celiac disease. Could there be a connection?  In fact, there are several important connections that are often over-looked.

In researching autoimmune disorders, I learned about a disorder called “Autoimmune Adrenal Hypofunction” or “Autoimmune Hypo-Adrenalism”, which sometimes occurs together with other autoimmune disorders.  As in other autoimmune disorders, the body produces antibodies targeted against its own tissues, in this case, the two walnut-sized adrenal glands that sit atop the kidneys.  While thought to be relatively uncommon, Autoimmune Hypo-Adrenalism is most closely associated with celiac disease.  In fact, I was quite surprised by the wealth of information on this association, based on many studies done in Italy and Ireland, both countries where celiac disease is common.  While the connection between other autoimmune disorders and celiac disease is generally accepted in the U.S., the case for adrenal insufficiency in relation to celiac disease has not appeared to have received as much attention.  So, it can’t hurt to mention this link here, since it has the potential to affect those with persistent fatigue and/or chronic inflammatory disorders such as interstitial cystitis, in which low cortisol levels may play an important role.

Stress, Food Allergies, and Nutrition

As anyone who has studied stress and the allergenic response knows, diet does matter.  One of the least recognized forms of stress is untreated or unidentified food allergies and sensitivities. 

In Dr. Wilson’s book, “Adrenal Fatigue – the 21st Century Stress Syndrome”, he writes, “It has long been observed that people suffering from adrenal fatigue have a definite increase in allergic responses or become allergic to things that did not previously bother them.” This is because levels of the adrenal hormone cortisol, the most powerful anti-inflammatory substance in the body drop, making it “more likely that the body will have severe allergic (inflammatory) reactions and that these reactions will be more severe.”

Another factor in adrenal function through is nutritional status.  As we know, many people with Celiac disease or gluten intolerance do have some underlying nutritional deficiencies, and these become more difficult to address as we age.  Certain vitamins and minerals are essential to replenishing and nourishing the adrenal glands.  Ideally, we’d obtain these essential nutritional components through our diet.  In cases of adrenal fatigue, it is important to discuss with your physician what you can do to help your adrenals recover, both by eating an ideal diet, and taking recommended supplements, including B-Vitamins, Vitamin C, Magnesium, and specific herbs and amino acids.

Symptoms of Adrenal Fatigue

Ten relatively common symptoms of adrenal fatigue are listed below:

• Fatigue
• Depression and memory difficulties
• Sleep Disturbances
• Migraine Headache
• An increase in allergies or the development of new allergies
• Alcohol Intolerance
• Low Blood Pressure and Low Body Temperature
• Blood Sugar Regulation Problems (Hypoglycemia)
• Low Libido & Hormonal Imbalances
• Inflammation
  

Testing for adrenal insufficiency isn’t rocket-science, but an established and useful diagnostic tool that might have important implications for poor regulation of inflammation as well as for general health.

The first step is to check for a low cortisol level, in combination with other hormones, including DHEA, Progesterone, Estrogen, and Testosterone.  This is easily done with a safe, reliable, and cost-effective serial saliva test, with four samples taken at specified time periods throughout the day.  Your physician often stocks these kits in the office, and can provide one for you to use and then mail to the laboratory.  The laboratory will perform the tests, and send the results to your physician, who will discuss them with you.  The whole process takes a week or two, and can be repeated every few months to track your recovery.  It is not expensive, and may even be covered by your insurance.

In fact, you do not need a doctor to order the test, but the results will be of little value without a physician to interpret them, make a plan to address any abnormal findings, and support and monitor you in your treatment.

Blood tests, including and ACTH challenge, may be indicated, but a serial saliva test is a good first step.

Adrenal Recovery

Any program of adrenal recovery must incorporate lifestyle changes that include avoiding stress or dealing with stress in healthy ways, such as exercise, relaxation, and meditation.  Eating an anti-inflammatory diet, free of sugars and alcohol, is essential, as continuing to follow a strict gluten-free diet.

This article is partially excerpted from “The Better Bladder Book – a Holistic Approach to Healing Interstitial Cystitis & Chronic Pelvic Pain through Diet, Lifestyle, & Self-Treatment”, available soon through my website.  The book provides documentation for all research and factual content, including the information in this article.

Nielsen Co., reports that the gluten-free products sector increased 20% in the 12-month period ending June 14, to $1.75 billion from $1.46 billion the year before. The overall market for food-allergy and intolerance products will approach $4 billion in 2009 according to New York research firm Packaged Facts. Since 2004, food retailers have added nearly 2500 new gluten free products to their shelves. In 2008 alone, retailers added more than 728 new gluten free products.

It’s not just people with food allergy, celiac disease and gluten intolerance hitting the checkout stand. Mintel estimates that nearly 10% of shoppers currently purchase gluten free foods, and Cynthia Kupper, executive director of the non-profit Gluten Intolerance Group of North America (gluten.net) says that 15% to 25% of shoppers are interested in purchasing gluten free foods—numbers far greater than the 1% of shoppers with celiac disease and gluten intolerance.

As restaurateurs and food purveyors at all levels look to stave off the effects of the recession, a number of them seem to be taking these numbers to heart. More and more of them are looking to see how incorporating gluten-free products into their lineup can help set them apart from the competition and bring in coveted consumer dollars.

Starbucks
At a time when Starbucks is making a concerted effort to save $400 million by brewing decaf after noon only by request, the coffee giant has admitted it is looking at offering a selection of gluten-free snacks as a way to strengthen sales and help its bottom line.

In fact, according to Starbucks "Ideas in Action Blog," Starbucks is soliciting advice from customers in the form of an informal online survey. Among the questions Starbucks is asking: "What specific gluten-free products would you like to see in our stores?" And: "The ingredient costs of gluten-free products tend to be higher, so would you understand if we charged more for the gluten-free version?"

With budget cutbacks touching so many Americans, and thus so many of its own customers, Starbucks, like numerous other vendors, is looking to maintain price premiums as a way to shore up their revenues. The idea is that certain specialty items still fetch a premium even in a recession. Gluten-free products are emerging as a strong contender in that arena.

Certainly, with gluten-free food numbers looking strong and growing through into the next decade, and Starbucks' reputation for visionary business action, the two look to be a logical union. If Starbucks can pull it off, it would be a major boost for the presence of gluten-free foods in mainstream markets.

Pizzeria Uno
One major chain that has moved from the gluten-free trial phase and into the full-fledged roll out phase with lightening speed is the Uno pizzeria chain.

The Pizzeria Uno chain recently found their limited-market trials of gluten-free pizza to be such a resounding success that they are pulling out the stops and moving with all haste to offer gluten-free pizza options at every one of their 200 restaurants nationwide.

Pizzeria Uno clearly understands the strength of the demand and is looking to place itself at the vanguard of commercial dining establishments offering gluten-free food.

If Uno's efforts to introduce gluten-free pizza to America are successful, they just might be changing the face of the pizza world forever. No word if they plan to add any one of the numerous and wonderful gluten-free beers to their menu! Stay tuned.

Some other examples include:

• General Mills recently announced in that it had reformulated Rice Chex to be gluten-free.
• Nestlé recently debuted BOOST Kid Essentials Drink a digestion-friendly, lactose free, gluten free drink that does not contain high-fructose corn syrup.
• Anheuser-Busch introduced Redbridge, a gluten-free beer made from sorghum that the company describes as: “a rich, full-bodied lager brewed from sorghum for a well-balanced, moderately hopped taste.”
• Hotel chain Four Seasons has announced that Executive Chef Robert Gerstenecker is implementing gluten-free baked goods for afternoon tea.
  

Recent news that Apple CEO Steve Jobs will be stepping down from his duties, at least temporarily, has fueled speculation both online and in mainstream media about both his condition and his prognosis, in addition to sending Apple shares tumbling downward.

Jobs announced in early January that he was suffering from a "hormone imbalance that has been robbing [him] of the proteins [his] body needs to be healthy," and which has led to dramatic weight loss. The announcement stated that Jobs' condition was due to a "nutritional problem" for which treatment is "relatively simple and straightforward."

Apple announced in mid-January that Jobs was taking medical leave through June. The SEC recently announced that it will undertake a review to ensure that investor notification of the health disclosure was timely and forthcoming. Still, the larger question remains: What ails Steve Jobs, and how will it effect Apple?

A number of people have speculated that Steve Jobs might be suffering from the effects of untreated celiac disease. Type the terms "Steve Jobs" and "celiac disease" into Google and you will get about 7,000 results.

In his piece in the Motley Fool, Tim Beyer notes that, according to sources cited by The New York Times, Jobs is suffering not from a recurrence of pancreatic cancer but from a condition that is "preventing his body from absorbing food." Beyer goes on to state: "I've said before that his condition sounds like celiac disease and I still believe that."

Jobs underwent an undisclosed procedure for a pancreatic tumor in 2004. Whipple surgery,  a common treatment for Pancreatic cancer, involves removing portions of the stomach, pancreas, bile duct and small intestine, and can interfere with digestion and nutritional uptake, even years later.

However, more than one doctor has pointed out that Jobs' description of the condition seems a bit confusing. Dr. Robert Lustig of UCSF Medical Center says that the statement "doesn't make a lot of sense." He goes on to point out that "[t]here are three medical threads that run through this e-mail, but unfortunately those threads don't make a very strong cable."

When asked if celiac-related hyperthyroidism might be explain Jobs' symptoms, Dr. Lustig noted that celiac disease does interfere with the body's ability to uptake nutrients, but that celiac disease is a digestive order, not the result of a hormone imbalance. Moreover, there is no single condition wherein a hormone imbalance and protein deficiency can be treated with a simple dietary change.

Still, thyroid problems, both Open Original Shared Link. Untreated celiac disease can cause intestinal damage, and prevent proper absorption of nutrients, including protein, leading to weight loss. Hyperthyroidism can cause hormone imbalance.

When asked if it was possible that Mr. Jobs' explanation had conflated two conditions, celiac disease, which would rob his body of proteins, and would also require a "nutritional therapy," together with hyperthyroidism, which would cause a "hormone imbalance," Dr. Lustig conceded that such a scenario was possible, but he declined to speculate upon the likelihood.

Dr. Lustig did point out that even if celiac disease and hyperthyroidism were at the root of Mr. Jobs' symptoms, that "neither celiac nor hyperthyroidism has anything to do with his previous pancreatic chromaffin cell tumor."

However, such a scenario would certainly dovetail with Jobs' statement, and would also explain the relatively "simple and straightforward" nature of the treatment; even related hyperthyroidism would be easily controlled with drugs (usually Methimazole).

In fact, if celiac disease and hyperthyroidism is at the heart of the problem, Mr. Jobs will likely face a very positive prognosis, as they are both treatable conditions. By following a simple course of drugs for hyperthyroidism, and by adopting a gluten-free diet for celiac disease, Mr. Jobs would be looking at a recovery period that would put him back in the saddle in just a few months, or around June, just the time he's scheduled to return to his duties at Apple.

• Robert Lustig, M.D. is with the Division of Pediatric Endocrinology at UCSF, and speaks on behalf of the Hormone Foundation, which is the public outreach arm of the Endocrine Society.
• Dr. Walter Willett is chair of the department of nutrition at the Harvard School of Public Health.
  

• Apple letter from Steve Jobs:
  Open Original Shared Link
• Motley Fool: Apple Out of a Jobs - Tim Beyers
  Open Original Shared Link
• TIME: What's Ailing Steve Jobs? Medical Opinion Varies - Tiffany SharplesOpen Original Shared Link
• Bloomberg: Apple Disclosures About Jobs Said to Face SEC Review (Update4) - David Scheer and Connie Guglielmo
  Open Original Shared Link
• Thyroid Problems Often Seen with Celiac Disease:
  Open Original Shared Link
  

1. Toss Out any Unsafe Foods
   The beginning of the year is a great time to go through your cupboards to make sure that any gluten-containing food that might have snuck into the house over the holidays is banished forever. Still have that fruitcake from your well-meaning aunt who forgot about your gluten-free diet? Toss it…or, maybe better, re-gift it to one of your gluten-eating friends (or enemies depending on the quality of the fruitcake!).
   
2. Restock your Kitchen
   Plan to include a gluten-free shopping list in that first grocery purchase to help you replace any depleted favorite gluten-free ingredients. The start of the year is a great time to re-stock your kitchen with your favorite gluten-free foods and ingredients.
3. Open Original Shared LinkTake Advantage of Sales/Specials to Stock up on Gluten-free Favorites
   Numerous online companies are eager to make way for 2009, and offer great deals on your gluten-free favorites. Whether it’s breads, pizzas, pizza crusts and mixes by companies like Chebe, Dad’s, Schar, Foods By George, or ‘Cause Your Special, now is a perfect time to stock up and save big.
4. Source Products from Reliable Makers and Vendors
   The ‘gluten-free’ label is becoming a hot commodity, with the market for gluten-free products growing at double-digit rates, and consumer demand higher than ever. However, until the U.S. government implements official standards, there is no official definition as to what constitutes a gluten-free product, so it’s buyer beware! So it’s best to buy your gluten-free products from trusted companies and sources. Look for companies that have a long history and are vigilant about protecting their customers. One of our favorites is the Open Original Shared Link, which has provided on-line shopping for such products since 1998.
   
5. Stay Informed
   Follow the latest Gluten-Free developments. From clinical trials of a vaccine for celiac disease, to the pending U.S. adoption of the Codex Alimentarius standards for gluten-free labeling, to major developments in diagnosis, treatment, associated conditions, etc., there’s plenty happening in the gluten-free world, so be sure to follow any news that might have a positive affect on your health and gluten-free lifestyle. You can follow your favorite authors and news on Celiac.com by setting up our Open Original Shared Link in your Google or Yahoo! account.  Or even better still, subscribe to a celiac disease or gluten-free newsletter such as Open Original Shared Link, and help support us at the same time.
6. Double-Check Safe and Unsafe Gluten-Free Food Lists
   You can find free Open Original Shared Link at Celiac.com. Another good option is to purchase a commercial Open Original Shared Link, which can help you find items at a regular grocery store that are safe.
   
7. Take Part in Food Planning for 2009 Events
   From post-New Year’s parties to the Super Bowl and beyond, now is a good time to look at the year ahead with an eye toward any events you’ll likely be attending and to make a mental note to chime in ahead of time with hosts to arrange for any gluten-free adjustments. This includes arranging to bring gluten-free versions of any favorite or ‘must-have’ dishes.
8. Think Ahead: Plan and Try Gluten-free Dishes in Advance
   Think back to the few disappointments you may have suffered at one of last year’s parties or picnics. Maybe it was the company get-together, maybe it was your cousin’s Superbowl party or Memorial Day BBQ, where there just wasn’t enough gluten-free snacks to nourish you properly. Don’t get caught short again. Now is a perfect time to look ahead and mark your calendar for the events you know will be coming. Then mark your calendar again for a date far enough in advance of those events for you to prepare and try out the gluten-free offerings that will help to make those events a gluten-free success!
9. Try new Gluten-free Products!
   With the market for gluten-free foods projected to grow at double-digits through foreseeable future, the number of gluten-free products hitting the market is also swelling. Since 2004, food retailers have added nearly 2,500 new gluten-free products to their shelves. In 2008 alone, retailers added nearly 750 new gluten-free products. Trying new gluten-free products is a great way to discover new products, and new manufacturers, and to enjoy eating gluten-free.
10. Spread the Word
    Generally speaking, a gluten-free diet is a healthy diet. On the whole, people who eat gluten-free automatically avoid a huge number of foods containing enriched wheat flour that pervades our food chain, and is often found in combination with other questionable ingredients like hydrogenated oils, high-fructose corn syrup, preservatives, etc. Eating gluten-free generally means paying closer attention to ingredients, eating foods made with a variety of whole grains, like quinoa, rice, corn, and millet, along with more fruits, and vegetables. A gluten-free diet is an invitation to a healthier lifestyle. Spread the word!
    

It was interesting reading the various responses, which resulted in a debate over whether or not to induce vomiting, drink pineapple juice, take enzymes or engage in a certain illegal activity.  In all the debate, the woman eventually disappeared off the forum, which probably meant that she took some action or another, though I never heard the final result.

This whole subject inspired some research on my part.  I first consulted my extensive gluten-free library, which led me to one solitary, repetitive answer: do not eat gluten.  In a world where doctors and authors alike are so concerned that their advice on the subject will lead people with gluten sensitivities to forgo a gluten-free diet in favor of a “band aid” of sorts, that finding a documented recommendation is near impossible.

These experts are right to reinforce the importance of maintaining a gluten free lifestyle, and the fact that there is no “cure” for gluten intolerance and celiac disease (other than complete avoidance of gluten from wheat, barley and rye).  But mistakes do happen, and from time to time people do get "glutened,” and when they do, which action is best?

No matter what the size is of the offending dose of gluten, all experts agree, inducing vomiting is too dangerous and disruptive to the body to be considered.  But there is one option that at least two noted experts in field of celiac research agree upon: enzymes.

When I contacted the renowned Dr. Kenneth Fine of EnteroLab, and asked him if perhaps a dose of enzymes that are designed to break down gluten might help, he had this to say: “The good news is that everyone will survive and recover from the gluten exposure.  The enzymes you mention might help, but not completely, unless they consumed at the same time (as the gluten) for best results.”  And like all good doctors, he did go on to warn, “Avoidance is still the best policy.”

Shari Lieberman, PhD, CNS, FACN and author of The Gluten Connection very humbly admits that “gluten slips happen.”  She also devotes a couple of pages in her book to research conducted using digestive enzymes to help manage those occasions when gluten does make its way into your diet, citing a research example in which “The study demonstrates that enzyme therapy can substantially minimize symptoms in people with celiac disease who are exposed to gluten.” 

The enzyme used in this study does not seem to be currently available, but other gluten enzymes are at your local health food store.  I contacted one company in regard to their product, which according to them helps to reduce inflammation caused by the introduction of gluten in an individual with celiac disease or gluten intolerance.  According to them their enzymes will not prevent all damage, but may reduce some inflammation and help the body to better digest the protein.

Ultimately, gluten sensitive individuals should recover from one accidental “gluten slip” here and there, and keeping some digestive enzymes handy to help cope with such an accident is not a bad idea.  But do keep in mind that repeated offenses, even the most minute, will damage your body and prevent it from healing.  Enzymes help treat the symptoms, but only complete avoidance of gluten can treat the disease.

While the above description doesn't make it sound very appetizing, what's the problem with xanthan?  Some people develop an allergy to xanthan, with gastrointestinal symptoms such as bloating, gas, and diarrhea.  Even consumption of a very minor amount can lead to days and days of recovery and many trips to the bathroom.  Hmm.  Sound like anything we've heard before?  And that's the problem.  Experiencing a xanthan reaction can make you question your gluten-free diet, make you think you were accidentally exposed to gluten, or mystify you completely.

A xanthan reaction can also precipitate migraine headaches, skin itchiness, and for those exposed to large amounts, such as bakery workers, nose and throat irritation.   Symptoms of xanthan sensitivity become more prevalent with increasing exposure, so that can be one important clue.  If you've suddenly started baking alot, or become addicted to a new brand of gluten-free cookies, and you start to have increased gastrointestinal symptoms, you may want to consider ruling out an adverse reaction to xanthan gum.

What's a body to do?  Guar gum makes a good substitute, and it is also less expensive.

How did I become aware of this?  Well, actually I have known about this for quite awhile, but since xanthan gum is in so many gluten-free products, I thought that sensitivity to xanthan must be a rare and isolated occurrence.  Then two things happened to change my mind.  I began baking a lot of gluten-free products for a business venture, and suddenly started having some gastro-intestinal problems, after being healthy for so long.  I didn't have the severe pain of a gluten reaction, but otherwise my symptoms were eerily similar, particularly the bloating.  I had already decided to lay off the baking (and tasting) as much as I could, and had narrowed the possibilities down to either tapioca starch or xanthan gum.   Then, a student in one of my cooking classes let me know that she had a severe allergy to xanthan, and described her symptoms.  They were identical, except in severity.

I reformulated my recipes using only guar gum for my next stretch of gluten-free baking, and I had no problem at all.  I certainly hope that I do not develop a reaction to Guar gum, which is the ground carbohydrate storage portion of the guar bean.  I have not seen reports of allergy or sensitivity to guar gum, but will do a little more research for my own knowledge, which I will share in the future.

By no means am I advocating that all people following a gluten-free diet give up products made with Xanthan gum.  But, if you do not feel that the diet is helping you, and are still symptomatic, a sensitivity to Xanthan gum is one possibility that needs to be ruled out.

Bread, Gluten-Free, Bread
For all of us, bread is troublesome if you’re on thegluten-free diet.Even if it followsyour restrictions, there’s no guarantee it is any good. That has been thebiggest hurdle for Ida.In Norway, shecan get fast food and the hamburgers have gluten-free buns.Can you imagine?“It is more difficult [here],” she toldme.“I eat a lot of Burger King,McDonalds, and pizza in Norway.We havea lot of gluten-free options.”She saysyou never have to worry about French fries either, as they aren’t contaminatedin the oil like most are in the United States.

In Norway, not only are the meals more complete (withbread), but they appear to “get” celiac disease.“Everybody understands what you’re saying,”Ida says.We all know here in the UnitedStates, getting a gluten-free burger at a restaurant means no bun. Eating pizza out isa rare treat only at certain restaurants that are willing to explore thepossibility.Right now in the entireTwin Cities area, I know of about 8 places in a 50 mile radius that have agluten-free pizza option.And even this is a hugeimprovement when compared to what was possible just a year ago.

Navigating the New Gluten-Free Culture
When Ida first got here, I explained to her just howill-equipped most of our restaurants, and many of the people who work there,are regarding specialized diets.While McDonald'shas lists of their gluten-free items on line, many of the people taking ordersdo not understand the first thing about food sensitivities and allergies oreven about what their establishment has to offer.

She got a quick guide on the main fast-food places that havegluten-free options, and how to order specialized foods.Also, every time I hear of a place that has agluten-free pizza option, I make sure Ida gets the information.I figure someday she would like to go outwith her friends for pizza.The bestexperiences dining out have been at restaurants with a specific gluten-freemenu (aren’t they all?).

For now her focus here is school, meeting new people andexperiencing the American culture instead of food and eating out.She is having a great time learning aboutAmerican football (her high school team is in the state championships) andheading out to the movies with her friends.I suppose as long as I have gluten-free food she can load up at home–she is doing pretty well.Ultimately she is a typical teenager, no matter what country she’s from.

Celiac.com 11/10/2008 - Dietary shifts in recent years towards more organic food choices and low carb diets have forever-altered the food pyramid—the grocery world is changing in response to our health concerns.  Now there is a new trend in the food world: the gluten-free diet.  According to Nielson reports, the gluten free sector of the grocery world grew 20% between June of 2007 and 2008.

With unarguable growth in this new direction, the word is spreading about conditions such as celiac disease and gluten intolerance.  But is gluten-free just the latest diet fad, belittling the severity of these diseases, or is it a trend in the right direction for the millions of Americans who are still undiagnosed?

One of the greatest fears surrounding the growth of the gluten-free trend is that people may indulge the diet for faddish reasons, discounting the severity of conditions such as celiac disease and gluten intolerance.

Celiac is an autoimmune disease that affects at least 1 in 133 Americans. When gluten is consumed, antibodies in the small intestines attack the gluten, damaging the intestinal lining and villi, small hair-like structures which extract nutrients from the food.  Without treatment, the body is rendered unable to absorb the proper nutrients from dietary food, leaving patients vulnerable to an entire host of serious, life-threatening diseases.  The prescribed treatment for celiac disease is an adherence to a completely gluten-free diet for the rest of the patient’s life.  Left undiagnosed and untreated, celiac disease can cause serious conditions such as cancer, osteoporosis and infertility.

Celiac disease is very serious, and it should not be discounted.  Far more common, and often as severe, however, is gluten intolerance.  Gluten intolerance can range in levels of severity, wreaking the same havoc on the body that celiac disease does, or in some cases simply causing gastrointestinal discomforts.  The key here is that gluten intolerance can in fact be as damaging to the body as celiac disease, and gluten intolerance is suspected to affect as many as 30% of Americans  (SOURCE: The Gluten Connection).

With every new trend comes controversy, but ultimately, the growth in interest in a gluten free diet will mean more research, more diagnoses and more food options.  Doctors often have a hard time diagnosing gluten intolerance and celiac disease, because of the broad range of symptoms and their lack of exposures to these diseases.  Patients often receive their diagnosis only after digging deeper, looking further than one or two doctors for the correct answer.

More coverage on these conditions, means more people with undiagnosed gluten intolerance or celiac disease will find their answer, and get the diagnoses they need.  People with gluten sensitivities are often very outgoing about them, and many write articles, post on forums, or start blogs.  One thing is for sure, the more people who get diagnosed, the more the word will spread.

Perhaps just as dietary trends or fads have taught us that carb-centric, processed food diets may not be the answer for optimal health, so too will the gluten free-movement correct our country’s addiction to the wheat-based diet.  Many argue that our diets should have never contained gluten to begin with, and today it is added to nearly all processed foods ranging from soups and sauces to seasonings and condiments.  The gluten-free diet may just be the latest trend for some people, but for many of us it is our only path to good health—and for this reason the gluten-free diet is here to stay.

Just before my celiac daughter’s kindergarten year began, I thought I covered all my bases.  I talked to the school nurse, Emma’s teacher, and the head of the cafeteria about her condition and her diet.  I found there was very little she could have at school except beef tacos, which she loved.  Eventually that one menu item, which made my daughter feel just like the rest of the kids, vanished; a near tragedy for her, sheer frustration for me.  I would ask myself “Why do the schools have to serve up so much food with gluten?” I also didn’t feel like I was taken seriously by the cafeteria employees.  I housed some small gluten-free food items in the freezer at school in case of emergency.  That expensive food was thrown away, with no one even realizing they did it.  That told me, they weren’t paying attention.  And I was done.  It seemed as though Emma was destined for cold lunches until she graduated from high school.  

Honestly, school lunches may not be the perfect meals for our children, but suddenly many parents feel an urgency to feed them school food when their celiac child starts to feel left out.

The good news is: times may be changing.  Sherri Knutson, Student Nutrition Services Coordinator for the Rochester, Minnesota School District, and her staff have developed a monthly gluten-free, menu for students.   “We’re making it come together…to meet the needs of the student,” Knutson said.  It is more like students!  As many as 20 children every day order from this menu which actually mirrors the “regular” monthly menu, including gluten-free chicken nuggets, spaghetti and hamburgers WITH a bun.  Knutson says they started slow in 2004, offering only a few gluten-free options each week and then expanded from there.

Offering the menu comes at a cost – to the district.  Officials with the US Department of Agriculture (USDA), which oversees the school lunch program, say schools cannot charge parents more for specialized, expensive diets.  A regular school lunch in that district costs $2.05, but the gluten-free lunch costs about double.  Knutson’s district essentially “eats” the cost.  “Cost is not one of the factors that should impact [implementing this diet in schools].”  But she admits they look into finding ways to cut costs, like baking their own gluten-free goodies.

Now word is spreading about this groundbreaking menu.  Knutson says she is getting calls from school districts across the country asking her how she does it.  Her answer is simple, start small and do what you can.  She also asks parents to be understanding and patient; accommodating the gluten-free diet is very new for most school districts. 

My conversation with Knutson was enlightening and empowering, but back at home I was struggling with my own district.  There were times in the last four years, where I wondered if the district even cared about my daughter’s health and nutrition needs.  After months of many unanswered emails and phone calls with my district nutrition department in late 2007 and early 2008, I finally called my school board member to get some attention.  That one phone call got the ball rolling.  In the six months since, I have had several meetings with key employees in the district and school.  My district also appointed a coordinator for specialized diets who works directly with schools that have special food requirements for certain students.  In October of 2008, I saw a first draft if it’s two-week, gluten-free menu.  The nutritionist I work with tells me it is just the beginning.  I am so pleased and proud of them for finally taking some much-needed action.

It is amazing how far you can come with a lot of work, tenacity and passion for equality.  If you are in the same situation that I was, I urge you to take action.  If your school cook won’t help you, go to the district nutrition director, if they won’t help you go to the superintendent, if they won’t help you go to the school board, and if they won’t help you, contact the education department in your state.  That group may oversee statewide compliance of USDA rules.  I was able to get this done without a 504 plan for my child.  Simply put, a 504 plan is detailed paperwork which gets you the needed accommodations for your child and their diet.  You may need to create a 504 plan to push along the lunch changes for your child.  Watch for much more on this important issue in upcoming posts.

I cannot guarantee you will get drastic changes in lunch offerings from your district, so if you are still in a slump, check out the Open Original Shared Link.  Serving specialized diets in school is a hot topic right now and the ACDA is trying to advocate for all of us.  Your child has a right to eat school food.  And this is one food fight – worth getting in on!

*For much more information on the Rochester, MN School District’s Gluten Free menu, see Open Original Shared Link I wrote for FoodService Director Magazine in September 2008.